The return of the Yellow Berets

When one contemplates service during the Vietnam War, many different images likely come to mind. Infantrymen patrolling in a thick jungle or carrying their rifles above their heads through rice paddies; helicopters flying overhead, like in Apocalypse Now. Men in olive fatigues walking along crowded Saigon streets snapping photos and looking for R&R. Yet, simultaneous with that vision, a different type of battle was also raging, with a long-term outcome that became the present academic medical culture. That battlefront involved young commissioned military officers as well: physician-scientists strategically situated at the National Institutes of Health in Bethesda, Maryland.

These physicians were just two years out of medical school. Titled lieutenant commanders, though more casually attired than their counterparts overseas, they were weaponized with the latest advances in science and visionary governmental support. An elite force, they insouciantly nicknamed themselves the “Yellow Berets.” The tag has stuck for five decades (there is an alternate and uncivil explanation for the term’s origin that it’s fair to reject on moral terms).

The program was more formally named the National Institutes of Health (NIH) Associate Training Program. It included a disproportionately large number of Yale School of Medicine graduates who had gained preferential admission thanks to their YSM-bound theses, which verified their aptitude for research.

A new audiobook, Soldiers of Science, covers the subject. Released in December 2020 and aptly narrated by actor Alan Alda, the former star of the long-lasting television series M*A*S*H (the acronym for mobile army surgical hospital), the book vividly tells the story of how the Yellow Berets accelerated the evolution of medicine into a science-driven discipline—a gift that delivers medical innovations to this day.

Virtually all male physicians were drafted during the Vietnam War, and typically destined for war zones with start dates immediately following their internships. As that war became progressively more unpopular, increasingly larger numbers of young physicians applied for the limited number of research training positions at the NIH. As a component of the Navy, the NIH provided an alternate path to fulfilment of one’s service obligation in a way that made good use of advanced scientific and medical degrees. The horrifying Tet Offensive in 1968 had underlined the danger of ground war, leading to intense competition for the 250 NIH Associate Training Program slots awarded each year. More than 40 highly qualified young doctors vied for each position.

Soldiers of Science has been reviewed favorably; it was launched when George Stephanopoulos interviewed Alda on Good Morning America. It describes how the NIH training program was instrumental in speeding the ascendency of investigative medicine, and serves as a cogent reminder of how astute governmental actions can influence medical progress in positive ways. The program also offers an example of how something exceptionally good can come from something uncommonly bad.

Of the roughly 2,000 participant physician trainees over the wartime decade from 1964 to 1974, roughly half seeded medical school faculties throughout the country following completion of their military service. Many of these young physician-scientists matured into field-shaping national medical leaders with an enormous collective impact that was in turn amplified by their successors. These same faculty members also served as role models for cutting-edge clinicians across all specialties. Since the interpersonal bonds the Yellow Berets formed persisted throughout their careers, the program’s graduates formed a national network that maintained and enhanced synergies.

The timeless effects of the program are evident today, with a high percentage of physician-scientists able to trace their career lineage back to the Yellow Berets. Soldiers of Science spotlights eight Yellow Berets to tell the story of the program. Anthony Fauci, MD, is the best-known Yellow Beret, as an NIH leader who directs the national battle against COVID-19. Five of the remaining eight are Nobel laureates.

Yale’s Richard Edelson, MD ’70, the Aaron B. and Marguerite Lerner Professor and chair of Dermatology, and formerly deputy dean for clinical affairs and Cancer Center director, was included for his key scientific discoveries, all traced back to his rich training as a Yellow Beret cancer immunologist. As the youngest of the group, he entered the NIH program at its peak in 1972. He identified a new type of T-cell lymphoma, cutaneous T-cell lymphoma or CTCL; elucidated the clinically relevant biologic features of the malignant cells causing this dangerous cancer; and used those malignant cells as investigative tools to explicate the fundamentals of T-cell biology.

Edelson then applied those insights to the design and implementation of extracorporeal photochemotherapy (ECP, also known as photophoresis), the first FDA-approved immunotherapy for any cancer. That treatment is currently administered worldwide in the majority of university medical centers throughout the United States and Europe. It is given not only to immunize patients against the cutaneous lymphoma that Edelson discovered, but also to treat transplantation reactions. His treatment has been administered more than 3 million times to more than 70,000 patients worldwide, with other potential clinical applications.

Said Edelson, “I am daunted to be part of this extraordinary group and thrilled to help represent the many other Yellow Berets, including my 20 YSM classmates and so many others. I am merely one example out of hundreds whose lives and careers were redirected and shaped by our shared great fortune to have been imprinted by the NIH experience.”

The NIH Associate Training Program provided young MDs with a chance to do research at a level that interwove cutting-edge clinical care with clinically relevant investigation. Talented and curious physicians in the midst of their clinical training were connected with world-class mentors and one another in a collaborative environment—without worries about research funding, and surrounded by patients with a broad array of instructive diseases.

The program made an impact elsewhere, too. The blending of research with clinical practice was essentially a forerunner of what evolved into medical school joint MD-PhD programs. As health care and medicine became increasingly specialized in the latter part of the 20th century, better funding and greater resources were needed to make advances. Taking part in the NIH Associate Training Program exposed younger scientists to the need for visionary federal support.

Proud to have been recognized through his inclusion in Soldiers of Science, Edelson fondly recalls the camaraderie of his NIH time. From the experience of bonding with colleagues, to playing on the NIH tennis team against other governmental agencies, to learning firsthand about the future of collaboration between government and academia, he enjoyed and is deeply grateful for the career grounding he obtained there.

“There’s no question in my mind that this program revolutionized modern medicine and led to systemic reforms that helped America take and solidify its lead in medical research,” said Edelson. “I was thrilled to be a part of it. When we look back to the origins of the skill sets and insights that we are relying on during this pandemic, we can count our blessings for the foundational contributions of the Yellow Berets.”